2.
HEALING
TISSUE HEALING GENERAL
Healing =ÊtheÊprocessÊofÊrestorationÊofÊtheÊtissue’sÊarchitectureÊ&ÊfunctionÊafterÊanÊinjury.
Healing results in 1 of 2 outcomes:
1st Intention = Regeneration (Resolution)
TheÊtissueÊreturnsÊapproximatelyÊtoÊitsÊoriginalÊstate.
TypicalÊforÊSkin,ÊIntestinalÊEpitheliumÊ&ÊParenchymalÊCells.
2nd Intention = Repair
TheÊtissueÊrepairsÊbyÊformationÊofÊaÊnon-functionalÊtissueÊ(“Scar”).
TheÊaimÊofÊtheÊscarÊisÊtoÊmaintainÊstructuralÊstability.
ThisÊoccursÊifÊtheÊdamageÊisÊtooÊsevere,ÊorÊinÊunrepairableÊtissuesÊ(Heart, Brain).
HEALING OF NECROSIS-MAIN FORMS
1. FIBROUS SCAR TISSUE
ComposedÊmainlyÊofÊcollagenÊfibersÊ&Êfibroblasts.
TakesÊaboutÊ6ÊweeksÊuntilÊfullÊscarringÊisÊformed.
ItÊisÊtheÊmostÊcommonÊhealingÊformÊofÊischemicÊnecrosis.
2. PSEUDOCYST
PseudocystÊ=ÊaÊcyst-likeÊfluid-filledÊlesion,ÊthatÊlacksÊofÊepithelialÊcellÊlining.Ê
ItÊisÊratherÊisÊlinedÊwithÊgranulationÊtissue.
OccursÊmainlyÊinÊtheÊPancreasÊ&ÊBrain.
3. DYSTROPHIC CALCIFICATION (DC)
DCÊ=ÊcalcificationÊthatÊoccursÊinÊdegeneratedÊorÊnecroticÊtissue.
SeenÊmainlyÊonÊAtheromatousÊplaquesÊ&ÊheartÊvalves.
HEALING OF INFLAMMATION-FORMS
NON-SPECIFIC GRANULATION TISSUE
ThisÊisÊhealingÊprocessÊofÊmostÊinflammatoryÊprocesses.
TheÊtissueÊisÊcomposedÊofÊWBCsÊ(clearÊtheÊdebris),ÊnewÊCTÊ&ÊNeocapillarization.
GRANULOMA FORMATION
GranulomaÊ=ÊaÊstructureÊformedÊbyÊtheÊimmuneÊresponseÊinÊcertainÊpathologicÊprocess.
InflammationsÊhealedÊbyÊGranulomaÊformationÊareÊdefinedÊasÊ“SpecificÊInflammation”.
Examples: TB, Syphilis, Sarcoidosis, Crohn’s Disease, GPA, reaction to foreign material.
A GRANULOMA IS COMPOSED BY:
NecroticÊCenter
SurroundingÊImmuneÊCells.
WOUND HEALING-PHASES
PHASE 1 (= RECONSTRUCTION) - STEPS:
StartsÊwithÊDebridement (=ÊremovalÊofÊtissueÊdebris)ÊbyÊenzymesÊ&ÊWBCs.
WBCsÊ cytokinesÊ fibroblastsÊ formationÊofÊGranulation Tissue.
CytokinesÊ Epithelial cells migrateÊtoÊtheÊsurfaceÊofÊtheÊwoundÊ sealingÊtheÊwound.
GranulationÊtissueÊcontainsÊMyoblastsÊ contraction ofÊtheÊwoundÊ easierÊhealing.
PHASE 2 (= MATURATION):
InÊthisÊstepÊtheÊfinalÊresultÊofÊtheÊwoundÊhealingÊisÊdetermined:
Regeneration HealingÊtoÊsimilarÊwayÊasÊbeforeÊ(1stÊIntention).
Repair HealingÊwithÊsomeÊtissueÊloss/damageÊ ScarÊ(2ndÊIntention).
KELOID FORMATION
KELOID =ÊanÊimpairedÊformÊofÊwound-healing,ÊinÊwhichÊaÊraisedÊscarÊisÊformedÊ&ÊitÊextendsÊ
fromÊtheÊboundariesÊofÊtheÊoriginalÊwound.
KeloidsÊareÊmostlyÊformedÊdueÊtoÊOverproductionÊofÊCollagen.
KeloidsÊshowÊfamilialÊtendencies,ÊandÊtheyÊareÊlikelyÊtoÊoccurÊafterÊsurgicalÊremovals
HEALING OF BONE FRACTURES-PHASES
PHASE 1 (= REACTIVE) – STEPS:
a. Injury/ImpactÊ HematomaÊ Inflammation.
b. InflammationÊ CytokinesÊ GranulationÊtissueÊformationÊ(fibroblastsÊ+Ê
angiogenesis).
PHASE 2 (= REPARATIVE) – STEPS:
a. FormationÊofÊcartilaginousÊtissueÊ=ÊSoftÊ(Fibrous)ÊCallus.
b. MineralizationÊofÊtheÊsoftÊCallusÊ BonyÊ(Osseous)ÊCallusÊ SpongyÊBone.
PHASE 3 (= REMODELING) – STEPS:
a. OsteoclastsÊ progressiveÊresorptionÊofÊformedÊspongyÊbone.
b. OsteoblastsÊreplaceÊtheÊresorbedÊsitesÊwithÊcompactÊbone.Ê
HEALING OF BONE FRACTURES-TYPES
DIRECT BONE HEALING
OccursÊinÊfracturesÊwhichÊhaveÊtheÊ2ÊendsÊofÊtheÊfractureÊeitherÊinÊcontact,ÊorÊhaveÊaÊveryÊ
smallÊgap.
InvolvesÊdirectÊformationÊofÊbone,ÊwithoutÊtheÊneedÊofÊCallusÊformation.
INDIRECT BONE HEALING
OccursÊinÊfracturesÊinÊwhichÊtheÊ2ÊendsÊofÊtheÊfractureÊareÊmoreÊdistantÊfromÊeachÊother.
RequireÊformationÊofÊcallusÊforÊhealing.
